title: Breast cancer treatment choice and mastectomy length of stay: a comparison of HMO and other privately insured women.
abstract: This study uses hospital discharge abstract data from five states (Massachusetts, New York, New Jersey, Maryland, and California) for two years (1988 and 1991) to investigate whether enrollment in an HMO affects nonelderly breast cancer patients' treatment choice (breast-conserving surgery or mastectomy) and hospital length of stay for women who have a mastectomy. Since HMO insurance creates financial incentives that differ from other types of insurance coverage, it is important to assess whether the type of insurance coverage affects the care received by breast cancer patients. Although the results vary from state to state, they suggest that HMO enrollees are less likely to receive breast-conserving surgery (relative odds =.93). However, an unambiguous interpretation of this findings requires better data on patients' opportunity costs and preferences, which also may vary with type of insurance coverage. Among women who had a mastectomy, HMO enrollment was generally associated with a 4.5% shorter average length of stay and a greater likelihood of a short stay (one or two days, relative odds = 1.21-1.29). A much higher proportion of mastectomy patients in California than in other states had a short stay. Follow-up of these women may indicate whether short stays lead to adverse long-term health effects.
authors.affiliation: Institute for Health Care Research and Policy, Georgetown University Medical Center, Washington, DC 20007, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hadley
authors.forename: J M
authors.initials: JM
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D002140:California; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008396:Maryland; D008404:Massachusetts; D015411:Mastectomy, Modified Radical / Q000191:economics / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D014481:United States